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Is There An Advantage To Telemedicine and Telehealth?

Picking up the latest Issue of the AARP Bulletin of July/August 2018, I was intrigued to read about latest news in telehealth or telemedicine. At least ten years ago, before smartphones were the rage, I remember visiting a former neighbor at his mother’s house. He is a doctor living in Israel who practices medicine via computer. At that time, he utilized a program similar to Skype to visit patients in rural America. This was my first introduction to telemedicine. Since then, I have not been updated on this recent phenomena until I read the article in the AARP Bulletin this week.

There are shortages of primary physicians in faraway and rural areas. According to a 2014 analysis, telemedicine is expected to grow annually at a rate of 18.2 percent through 2020. According to AARP, expansion of telemedicine promises to provide high quality medical care for older adults with chronic health conditions that directly affect their mobility. Telemedicine holds considerable hope in providing superior medical care without the bother of commuting to and from appointments by bringing quality medical care directly to the home. Many patients are in favor of telemedicine for numerous reasons. For example, surveillance of patients after they leave the doctors office. Typically, patients are responsible for their own health when they return home from the hospital, outpatient procedure, or medical checkup. If the patient lives far from his or her physician, they may neglect to follow up on a treatment plan. Of course, this can cause serious health issues for the patient. Telemedicine can reduce actual trips to the emergency room in certain instances as well.

Follow up nursing care by visiting nurses is quite time consuming for nurses especially the driving time from one patient to another. Audio and video monitoring can simplify remote health care. Even technological devices such as stethoscopes, blood pressure monitors and thermometers can be used remotely by having bluetooth connectivity. The “visiting” nurse will have more time to spend speaking and educating the patient, resulting in better use of their time which is lost by travel to long-distance patients. In addition, it helps address one of the big healthcare issues in the United States of nursing shortages.

One of the most common technology settings is the two way audio and video teleconferencing equipment. Infrared technology offers a continuous monitoring method for telemedicine candidates. An elderly patient in a nursing home, for example, would not even have to leave his bed or log into the computer by themselves. This is especially beneficial to families of a patient who live far away. Injuries, falls or sickness can be easily detected by such a system offering prompt medical or nursing care for the patient.

Telemedicine saved the life of an infant from Oregon in the following story. Seven month old, MaLea Fox awoke with a fever of 102.4°. Since they were unable to get in touch with the baby’s pediatrician, MaLea was rushed to a local hospital in Seaside. Doctors determined that a virus was to blame after taking a series of tests including blood work. She was sent home and immediately fell asleep. It was hard for her mom to arouse her after sleeping for four hours so her mother took her to a different hospital. Luckily the doctor on duty at Columbia Memorial Hospital, in Astoria ,Oregon, had the intelligence and foresight to consult telemedically with Dr. Jennifer Needle, a pediatric specialist. Dr. Needle examined MaLea via a two-way communication system, a robot-like device at MaLea’s bedside while she sat a a telemedicine computer at Oregon Health & Science University Doernbecher Children’s Hospital. Dr. Needle of Portland, could see the baby’s symptoms, which included a rash and high fever. She was able to check the baby’s vital signs and other pertinent information. She noted that the rash was so intense, “she ended up looking like a burn victim”. MaLea was diagnosed telemedically, with meningococcemia, a life threatening bacterial infection. Dr. Needle recommended having a breathing tube inserted into MaLea’s throat before having her transported by helicopter to Portland. More drama ensued as the helicopter was forced to turn back to Astoria because of fog. It took over six hours to get her to Portland, finally making it by plane. The breathing tube, or incubation fortunately saved her life.

Non-clinicians can retain specialists to help diagnose difficult situations. A hospital chain in Arizona uses a combination of a team of doctors at the hospital with a combination of telemedicine and home-monitoring techniques. These practices reduce unnecessary hospitalizations by an unbelievable 45% causing costs to plummet by a third.

I read an amazing article online written from an NPR program on “All Things Considered” by Emily Foreman ( November 24, 2017), about a doctor in Indiana, who is an addiction specialist. President Trump declared the opioid epidemic a public health emergency and changed regulations to include the allowance of doctors to prescribe addiction medicine without ever seeing the patient in person. Dr. Jay Joshi runs Prestige Clinics in Munster, Indiana. He is a nationally recognized board certified anesthesiologist and fellowship trained interventional spine and pain management physician. Every Tuesday, Dr. Joshi’s patients chat through video with a tele-psychologist who lives 140 miles away.

One of his patients, Elizabeth Hall is a former nurse’s assistant and has been with Dr. Joshi for about a year for treatment of back pain and heroin addiction. She must prove that she is in counseling in order to get reimbursed by her insurance. Since it was difficult for Hall to find a competent counselor in her neighborhood, she chose a tele-psychologist with Dr. Joshi’s recommendation.

One of the insurance companies requirements in Hall’s treatment regiment is for her to use urine tests to determine if she used drugs. Since she unfortunately had taken a dose of heroin the previous week the tests showed up positive in her urinalysis. Dr. Joshi asked her to speak to the tele- psychologist about it. She promised the telephychologist that she will remain clean of drugs. Now because of the failed drug test, Dr. Joshi must intervene before the insurance company cancels her coverage of the Suboxone prescription.

Even though, Dr. Joshi advises his patients to consult with the psychologist remotely, he wants to see his patients in person to prescribe the anti-addiction medication. Dr. Joshi believes that face-to-face interaction allows a trust, and the body language of the patient is important to him as well. By meeting face to face, he can more accurately determine if the patient is taking their medication or selling it.

On February 9, 2018, President Trump signed into law, the Chronic Care Act. This law expands telehealth coverage under Medicare Advantage plans. For example, it will allow nationwide reimbursement for  stroke victims and home dialysis treatment. These improvements were added on to the recent ruling by the Centers of Medicare and Medicaid Service to cover telemedical monitoring for the millions of Medicare members with chronic health conditions. This system was recently implemented at the United States Department of Veterans Affairs. U.S war veterans now have the option to communicate with a doctor or have access to a specialist via telehealth.

Some medical scientists envision a future of technology in the medical field as astounding. The medical data of patients will be shared and compared by databases using powerful computer software. In a few decades, implanted devices will reduce the need for traditional doctor’s visits. Potential problems will be identified before they become serious, and the patient himself could be told what to do telemedically. For more complicated issues, the system will alert emergency services. Strokes and heart attacks could be virtually eliminated and ambulances and emergency hospital rooms will concentrate on accident victims only. One of the amazing benefits of this technology is that insurance premiums will drop since people will be monitored regularly. In one study it was noted that the use of telemedicine could eliminate as much as 387,000 emergency transports annually which would add up to a savings of $327 million per year.

More private insurers are starting to pay for telemedicine. This is a big step for people who are not eligible for Medicare or Medicaid. One obstacle in this new frontier is the danger of confidential information floating around the internet. There is a need to develop specific regulations so the health-care professionals can use this new technology to the max while still saving the foundation of high-quality health care, and the patient-doctor relationship.

Today, most of us are still of the opinion that seeing is believing. There are now urgent care centers in every town and some of them are open until late at night. People are able to see doctors or physicians assistants most conveniently. Housecalls by health care professionals are coming back in style. People, including myself have certain reservations about telemedicine. Patient to doctor relationships will suffer even more than they do now. Presently doctors have to see as many patients a day as possible to make a living. With telemedicine doctors worry that they may get paid less if the insurance coverage is less for telemedical visits than in person appointments. For some maladies, like, strep throat it would be best to see the doctor in person.

Besides for its express treatment, telemedicine provides another benefit in that it would help diminish  medical waste in Indiana and other U.S. states. Less patients will be occupying the waiting rooms  and reduces the risk of spreading disease. All too often people with poor immune systems end up catching some virus while seeking treatment in hospitals and clinic’s.

By incorporating telemedicine into our healthcare programs there will be significant financial benefits. Such treatment could reduce the cost of our medical facilities by seeing less visitors. The American Institute For Stress claims that 75% – 90% of all visits to primary care physicians are for stress related problems. Telecommuting with a patient can certainly address these non invasive issues but more importantly high risk cases will begin to get immediate attention. Doctors in emergency rooms across the globe already use this type of communication and will be glad more then to make themselves available for clients and give them express treatment.

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